RU2796320C1 - Method of shock wave therapy of the cervical spine - Google Patents

Abstract

FIELD: medicine; physiotherapy; manual therapy.

SUBSTANCE: invention is intended for the treatment of pain syndromes in the cervical spine (CS). The method includes performing procedures of shock wave therapy (SWT) using a spinal Y-shaped nozzle: the number of strokes of SWT apparatus for processing the entire zone of the SHOP is set to 5,000 and the frequency of strokes is 10 Hz with the initial pressure of the shock wave exposure at the level of 1.5 bar. Painful zones of the paravertebral muscles in the area of the SHOP are revealed by palpation, then UV exposure is carried out starting from the most painful zone, the ends of the Y-shaped nozzle are set to the most painful zone on the one hand and the zone symmetrical to it on the other side, an initial pressure level of 1.5 bar is used until a feeling of pain dulling appears. Then a less painful area and the area symmetrical to it are affected until a feeling of pain dulling appears. Afterwards, all the identified painful zones of the paravertebral muscles are affected. Then the pressure is increased to 2.0 bar and the SW exposure is repeated towards the same painful zones, followed by an increase in the pressure level to 2.25 bar, moving from zone to zone when the patient feels a dulling of pain. Then the remaining number of strokes up to 5,000 is performed, driving the spinal Y-shaped nozzle from the occiput to the 7th cervical vertebra, without breaking away from the paravertebral muscles, with a constant pressure of 2.5 bar. The number of procedures per course is 6 with intervals of 1 day.

EFFECT: method provides a reduction in the duration of the course of treatment and the achievement of earlier terms for the elimination of pain; reduction of the recovery period of incapacity for work in all categories of patients due to the easier-to-perform SWT technique with the number of 5,000 strokes and the use of a new spinal Y-shaped nozzle, which simultaneously affects the symmetrical zones of the paravertebral muscles in the CS area, providing the training of muscles on both sides with the same number of strokes and without causing muscle imbalance and asymmetric effects.

1 cl, 2 ex

Description

The invention relates to medicine, physical and manual therapy, can be used as a method of treating patients with pain in the cervical spine (CS) of various etiologies.

Studies conducted after the 2000s have shown that osteochondrosis of the spine and back pain have rejuvenated. Very often, this diagnosis began to be made not even for a socially active group of the population, but for children. At the same time, the disease often takes a chronic, relapsing course, which often leads adolescents to disability (Chelnokov V.A. 2004, Chelnokov V.A. 2005, Kotelnikov G.P. 2006, Podchufarova E.V. 2010, Torishneva E.Yu. 2009). According to the literature, one fifth of people out of 100 who still decide to seek medical help from doctors due to degenerative-dystrophic disease of the spine are sent for treatment to hospitals, while in almost 40% of cases long-term expensive treatment is required on an outpatient basis up to 14 days (Gitun T.V. 2013, Bantieva M.N. 2013, Leontieva E.Yu. 2018, Butukhanov V.V. 2014, Lalayan T.V. 2018).

The effect of shock wave therapy (SWT) is based on the action of acoustic waves that freely pass through soft tissues and are partially reflected from denser ones (cartilage, bone, ligaments). This creates the effect of an impulse internal massage, which activates blood circulation, increasing blood flow to damaged tissues. Due to this, natural regenerative processes and internal reserves of the body are activated, which begin to work for the regeneration and renewal of tissues. In combination with other methods, SWT has a powerful analgesic and restorative effect, which provides fast and long-term relief of neck pain.

UVT is effective in cervical osteochondrosis: it quickly stops the manifestations of the disease by reducing bone growths, accelerating metabolic processes, blood circulation, and tissue regeneration. Feeling better after 1-2 sessions. The impact is carried out by an acoustic wave of low frequency, which has a high pulse pressure, the ability to create a rarefaction zone and high speed. Thanks to these parameters, such a wave does not damage soft tissues, working only in a given zone.

There are 3 stages of impact:

- calmness - in the absence of radiation of impulses (shocks);

- high pressure (up to 500 bar);

- rarefaction (negative pressure after wave extinction).

With this sequence, the sound wave first "compresses" living tissue cells in the area of action, and then they "stretch" under the influence of vacuum. Receiving such mechanical stimulation, cells activate their functions, angiogenesis and microcirculation improve.

For muscles, there are effects of eliminating spasm, improving ion exchange in the cell and intercellular space, for nerve endings - blocking the reflex pain arc, for tendons - anti-inflammatory effects, increasing elasticity, etc.

As a result of such a complex effect of UVT on the body, the phenomena of adhesions, fibrosis, and calcium deposits, which are characteristic of cervical osteochondrosis, decrease. The main action is observed in the area of inflammation.

A known method for the treatment of inflammatory and degenerative diseases of the spine and intervertebral discs (patent RU 2436606 C1, 20.12.2011, Kravchik M.G.), which consists in a 2-stage approach. At the first stage, the authors propose to conduct a course of complex therapy, including microwave heating, electrical stimulation of the affected nerve, and anti-inflammatory drug therapy. At the second stage, it is proposed to conduct at least one session of focused extracorporeal SWT.

The disadvantage of this method is the need for repeated X-ray control images to control the regeneration process at the second stage of treatment with SWT. Since all patients undergoing vertebrological treatment undergo an x-ray examination before starting therapy, it is undesirable for health to perform it in such large quantities. In addition, the process of performing the second stage, including UVT, according to the authors of the known method, takes from 1 session to 2 months (30 sessions). Such a wide variation in the recommended number of sessions makes it difficult to choose a doctor in terms of the required number of procedures, which can be done, including the results of an X-ray study, but this in itself is undesirable. According to the authors of the known method, the average time required for the second stage is up to 2 months. However, most patients do not have the opportunity to undergo such a long treatment.

Another serious disadvantage of this known method is the first stage of anti-inflammatory therapy with NSAIDs and glucocorticosteroids. However, this approach is contraindicated in patients who have stomach problems, high blood pressure and blood sugar.

The closest analogue (prototype) of the proposed method in terms of essence and the achieved result are recommendations from the teaching aid of the team of authors: Bodrova R.A., Chistova V.V., Serova D.D., Dolgopolova A.S. "Application of shock wave therapy in various diseases of the musculoskeletal system". Kazan. 2013, pp. 13-14.

The essence of the method is that the authors recommend performing SWT with the radial head of the device in the area of the CCS from the occiput to the 7th cervical vertebra, first on one side of the spinal column along the paravertebral muscles, and then on the other side. The number of strokes per session is 2000, the pressure is from 0.3 to 3.0 bar, the pulse frequency is from 5 to 14 Hz. The number of sessions per course is from 2 to 5.

The disadvantage of this known method is, firstly, a small number of strokes - 2000 pulses are not enough to eliminate the pain syndrome even at one pain point, and in patients with pain in the CS, as a rule, the length of the discomfort zone is from the occiput to the 7th cervical vertebra on either side of the spinal column. In this regard, 2000 impacts on such a voluminous area is an extremely small number.

The second disadvantage of this recommendation is the use of standard non-spinal attachments of the UVT device. Performing the procedure at a frequency as low as 10 Hz and a pressure above 2.1 bar in the SHOP zone, when the authors use standard nozzles that provide targeted point impact, causes severe patient discomfort, which in some cases is manifested by severe cough and pain and does not allow continuing the procedure.

The third disadvantage is the lack of an indication of how long it is necessary to “break” the painful area, i.e. how many strokes / impulses should be applied to one painful area. That is, the technique for performing the procedure remains not fully understood.

The fourth disadvantage is the uncertainty of the number of sessions required (from 2 to 5) and the presence of large intervals between sessions (on average 5-7 days). With this implementation of SWT, the patient begins to feel a significant decrease in pain only by 3-4 sessions. After the first session, a short-term exacerbation of the pain syndrome may develop, which makes it impossible to prescribe SWT for a course of less than 5 sessions. Conducting SWT at the SHOP once a week in a large number of patients does not lead to the desired analgesic effect, but only prolongs the course of treatment.

The fifth disadvantage of the known method is the use of standard radial nozzle heads recommended by its authors, which leads to uneven treatment of symmetrical muscles by the doctor and, accordingly, uneven relaxation of the paravertebral muscles, since with such nozzles it is necessary to strike first from one, then from the other side of the spine along paravertebral muscles, and this unevenness can lead to muscle imbalance.

This drawback is eliminated by using a spinal Y-shaped nozzle, which allows you to simultaneously impact the symmetrical zones of the paravertebral muscles in the SHOP area. In 90% of cases, the pain syndrome in the CS is bilateral, and then the “mirror”, symmetrical SWT exposure using a Y-shaped nozzle ensures that the muscles on both sides are worked out with the same number of strokes. They are distributed evenly on each working end of the Y-shaped nozzle, for example, a given 2500 strokes are distributed in 1250 strokes on each side. With this treatment, muscle imbalance does not develop, and there is an improvement in blood circulation on both sides of the SHOP.

Thus, the objective of the proposed method of UVT therapy is to create an easier-to-perform and effective SWT technique using a new spinal Y-shaped nozzle, which makes it possible to reduce the duration of the course of treatment, while achieving earlier terms for eliminating pain in the CS without causing muscle pain. imbalance, asymmetric effects. In addition, it has been experimentally established that 5000 strokes are sufficient to treat the entire zone of paravertebral muscles in the area of the CS, and our task was to develop a technique for changing the pressure of exposure and determining the conditions for ending the treatment of each painful zone and moving on to the next such zone.

The technical result is more comfortable for the patient, as well as a quick and technically simple elimination of pain in the SHOP, accompanied by a reduction in the recovery period of disability in all categories of patients.

To achieve this technical result, a UVT SHOP method is proposed, for the procedures of which a spinal Y-shaped nozzle is used.

At the same time, at the first stage of each procedure, the doctor adjusts the SWT device with an attached spinal Y-shaped nozzle: sets the number of strokes for processing the entire SHOP zone - 5000 and the frequency of strokes - 10 Hz, sets the initial pressure of the shock wave (SW) exposure at the level 1.5 bar.

At the second stage of the procedure, the doctor by palpation reveals the pain zones of the paravertebral muscles in the area of the patient's SHOP.

At the third stage of the procedure, the doctor conducts a direct UV exposure using a spinal Y-shaped nozzle on the pain zones identified at the second stage, starting with the most painful for the patient, after applying a universal colorless gel for ultrasound examinations to the skin of the SHOP zone.

At the same time, for the implementation of the SW impact, the two ends of the spinal Y-shaped nozzle are installed, respectively, on the most painful zone on the one hand and the zone symmetrical to it on the other side of the paravertebral muscles in the area of the patient's SHOP and act with an initial pressure level of 1.5 bar by blows on these zones of the paravertebral muscles simultaneously to the left and right of the spine until the patient has a feeling of dulling pain.

After that, the doctor, having moved the spinal Y-shaped nozzle, with an initial pressure level of 1.5 bar, acts on the next less painful zone and is symmetrical to it until the patient feels a dulling of pain, thus treating all the identified painful zones of the paravertebral muscles in the patient's SHOP area.

Then the pressure is increased to 2.0 bar and the SW-exposure is repeated over the same successive painful zones, moving from zone to zone when the patient feels a dulling of pain.

Then the impact is repeated on the same successive painful zones at a pressure level of 2.25 bar, moving from zone to zone when the patient feels a dulling of pain.

At the fourth stage of the procedure - after UV-treatment of all painful areas of the SHOP, the doctor, using the spinal Y-shaped nozzle, performs the remaining number of strokes up to 5000, driving the spinal Y-shaped nozzle from the occiput to the 7th cervical vertebra, without breaking away from the paravertebral muscles , with a constant pressure of 2.5 bar.

The number of procedures per course is 6, with intervals of 1 day (every other day).

The principle of gradual increase in pressure provides for its consistent increase. Typically, pain relief in each of the successively treated painful areas is achieved with about 2500 strokes at a pressure of 1.5 bar. At a pressure level of 2.0 bar, such dulling of pain is observed in painful areas, as a rule, when reaching 3500 impacts. Then the pressure is set to 2.25 bar and all the painful zones are repeatedly treated sequentially, starting with the most painful, until the patient feels a general dulling of pain in the SHOP during such exposure. This is achieved, as a rule, at the level of approximately 4500 strokes.

Further, the pressure is increased to 2.5 bar, and, evenly moving the spinal Y-shaped nozzle from the occiput to the 7th cervical vertebra, without breaking away from the paravertebral muscles, with this constant pressure of 2.5 bar, the doctor brings the number of remaining strokes to 5000.

To implement SWT in the framework of the proposed method, the SWT apparatus Gymna ShockMaster 500, Germany, with a spinal Y-shaped nozzle is used.

For preliminary treatment of the skin of the SHOP area, a universal colorless gel for ultrasound, physiotherapy, for example, Mediagel, is used.

Clinical examples.

1. Patient V., 25 years old. Diagnosis: Widespread osteochondrosis of the spine. Cervicalgia, protrusion of intervertebral discs C4-C5, C5-C6, muscular-tonic syndrome.

Complaints of pain in the SHOP, pain when moving both to the left and to the right.

On examination: hypersthenic physique, normal nutrition. Asymmetry in the standing of the shoulder girdle, shoulder blades in height (lower on the right than on the left). Cervical lordosis is smoothed, thoracic kyphosis and lumbar lordosis are preserved. Scoliosis GOP, POP (thoracic and lumbar spine). Restriction of mobility in the SHOP, lateroflexia C0-C1. Functional blocks at the level C0-C1, C4-C5, C5-6. Pain on palpation of the SHOP in the region of the transverse processes on both sides under the occiput and at the level of C5-C6. Active movements in the SHOP are sharply limited, painful.

SWT SHOP was performed with a spinal Y-shaped nozzle.

Completed 6 sessions (procedures) at intervals - every other day.

After determining the painful zones in the amount of 2, which corresponded to the patient's complaints when viewed at the level under the occipital tubercles and at the level of C5-C6, the initial adjustment of the UVT apparatus was performed and Mediagel was applied to the skin in the SHOP projection. Initially, 5000 beats were set, the beat frequency was 10 Hz. The first 2500 strokes were carried out at a pressure of 1.5 bar. With the first 1250 strokes, the first pain zone under the occipital tubercles was worked out until the pain was dulled. With the second 1250 strokes, the second pain zone was worked out at the level of C5-C6, also until the pain was dulled.

After 2500 strokes, the pressure was increased to 2.0 bar. The patient at increased pressure was re-examined the same pain zones until the sensation of complete blunting of the pain syndrome. Upon reaching 3500 strokes, the pressure was raised to 2.25 bar and the treatment of the same zones was repeated, moving from zone to zone when the patient felt a dulling of pain. When a total of 4500 strokes were performed, the pressure was set to 2.5 bar and was no longer raised until the number of strokes remaining up to 5000 was reached. occiput to the 7th cervical vertebra, without breaking away from the paravertebral muscles, with a constant pressure of already 2.5 bar.

After the 3rd session, the patient noted a significant improvement in her condition, the pain syndrome regressed 2 times. The volume of active and passive movements has expanded.

After the 5th session, the patient noted an almost complete regression of pain in the area under the occiput and at the level of C5-C6.

After a course of 6 sessions, the pain syndrome was completely stopped, the range of motion in the SHOP was not limited.

2. Patient K., 50 years old. Diagnosis: Osteochondrosis SHOP. Cervicalgia, herniated discs C1-C2, C3-C4, C5-C6, muscular-tonic syndrome.

Complaints of pain in the SHOP, pain when moving both to the left and to the right.

On examination: asthenic physique, normal nutrition. Smooth standing of the shoulder girdle, shoulder blades in height. Cervical lordosis is smoothed, thoracic kyphosis and lumbar lordosis are preserved. Scoliosis SHOP, GOP. Decreased painless range of motion in the SHOP. Functional blocks at the level C0-C1, C1-C2, C3-C4, C5-C6. Pain on palpation of the SHOP in the region of the transverse processes on both sides under the occiput and at the level of C1-C2, C3-C4, C5-C6. Active movements in the shop are sharply limited.

SWT SHOP was performed with a new spinal Y-shaped nozzle. Completed 6 sessions at intervals - every other day.

After determining the painful zones in the amount of 4 - at the level under the occipital tubercles and at the levels of C1-C2, C3-C4, C5-C6, the primary adjustment of the UVT apparatus and the treatment of the skin in the SHOP projection with Mediagel were performed. Initially set to 5000 beats, the beat frequency was constantly 10 Hz. The first 2500 strokes were performed at a pressure of 1.5 bar. With the first 625 strokes, the first pain zone under the occipital tubercles was worked out until the patient felt a dulling of pain. The second 625 strokes worked out the second pain zone at the level of C1-C2, also until the feeling of pain dulling. The third 625 strokes and the fourth 625 strokes worked out the pain zones at the level of C3-C4 and at the level of C5-C6, respectively, until the patient felt pain dulling, which was achieved with a number of strokes of 2500. After that, the pressure was increased to 2.0 bar . The patient at this increased pressure underwent repeated study of all four painful paravertebral zones until the feeling of complete dulling of the pain syndrome in each of them, which was achieved with a total number of strokes of 3500.

After that, the pressure was raised to 2.25 bar, and at this pressure, all the listed pain zones were worked out sequentially again until the feeling of complete dulling of the pain syndrome in each of them. This was achieved with a total number of strokes of 4500. Then the pressure was set to 2.5 bar and the number of strokes was increased to the final one - 5000. At the same time, from 4500 strokes, the patient underwent a uniform study of all paravertebral soft tissues by exposing the Y-shaped spinal attachment from the occiput to 7th cervical vertebra, without breaking away from the paravertebral muscles, with a constant pressure of 2.5 bar.

After the 1st session, the patient noted an improvement in the condition, the pain syndrome began to regress in the area under the occiput and at the level of C5-C6.

After the 2nd session, the volume of active and passive movements expanded. The patient felt an improvement in the area under the occiput, at the level of C5-C6, C3-C4.

After the 4th session, the patient noted an almost complete regression of pain in all 4 zones. Active and passive movements in the SHOP are practically not difficult.

After a course of 6 sessions, every other day, the pain syndrome was completely stopped, the range of motion in the SHOP was completely restored. There is no muscular-tonic syndrome.

Claims (10)

The method of shock wave therapy (SWT) of the cervical spine (SWT), characterized in that a spinal Y-shaped nozzle is used for SWT procedures, at the same time, at the first stage of each procedure, the doctor adjusts the SWT device with an attached spinal Y-shaped nozzle: sets the number of strokes for processing the entire SHOP zone - 5000 and the frequency of strokes - 10 Hz, sets the initial pressure of the shock wave (SW) exposure at the level 1.5 bar; at the second stage of the procedure, the doctor by palpation reveals pain zones of paravertebral muscles in the area of the patient's SHOP, at the third stage of the procedure, the doctor conducts a direct UV exposure using a spinal Y-shaped nozzle on the pain zones identified at the second stage, starting from the most painful for the patient, having previously applied a universal colorless gel for ultrasound examinations to the skin of the SHOP zone, at the same time, for the implementation of the SW-impact, the two ends of the spinal Y-shaped nozzle are installed, respectively, on the most painful zone on the one hand and the zone symmetrical to it on the other side of the paravertebral muscles in the area of the patient's SHOP and act with an initial pressure level of 1.5 bar by blows on these zones paravertebral muscles simultaneously to the left and right of the spine until the patient feels a dulling of pain, after which the doctor, having moved the spinal Y-shaped nozzle, with an initial pressure level of 1.5 bar, acts on the next less painful zone and is symmetrical to it until the patient feels a dulling of pain, thus treating all the identified painful zones of the paravertebral muscles in the patient's SHOP area, then the pressure is increased to 2.0 bar and the SW exposure is repeated over the same successive painful zones, moving from zone to zone when the patient feels a dulling of pain, then the exposure is repeated over the same successive painful zones at a pressure level of 2.25 bar, moving from zone to zone when the patient feels a dulling of pain, at the fourth stage of the procedure, after shock-wave treatment of all painful zones of the SHOP, the doctor, using the spinal Y-shaped nozzle, performs the remaining number of strokes up to 5000, driving the spinal Y-shaped nozzle from the occipital tubercles to the 7th cervical vertebra, without breaking away from the paravertebral muscles, with a constant pressure of 2.5 bar; the number of procedures per course - 6 with intervals of 1 day.